Women and Crack-Cocaine Use: A Study of Social Networks and HIV Risk in An Alabama Jail Sample

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Abstract
Although the crack-cocaine 'epidemic' has been well documented in the USA, little is known about its prevalence in the rural south. Crime statistics, anecdotal evidence and drug treatment reports indicate that crack-cocaine use has emerged as a significant social phenomenon in Alabama. The increase in pediatric and heterosexually-transmitted HIV/AIDS among African-Americans in Alabama suggests that the increase in crack-cocaine use and HIV/AIDS may be linked. This study sought to investigate the link between crack-cocaine use and HIV transmission in a small group of incarcerated Alabama women jailed for illicit drug use or drug-related crimes. The study was organized into focus group interviews consisting of three to six women (total eighteen), who discussed the topics of drug use, initiation and distribution, sexual activity, condom use and social networks in audiotaped sessions. The ratio of African-American to Caucasian women was 3:1, with ages ranging from to eighteen to fifty-three years. The use of crack-cocaine was said to be prompted by male intimates, with co-factors such as 'rite of passage' (African-American women) and 'life trauma' (Caucasian women) also reported. While drug distribution networks were primarily the domain of men, women reported being given more or better quality crack-cocaine, and being assigned the role of purchaser for male friends and partners. Sexual exchange or barter was commonplace; however, condom use was sporadic or the prerogative of men. While condoms were most often used in sexual activity with strangers, they were rarely used in sex with friends or regular partners. Social networks consisted primarily of male intimates and men identified as 'drug buddies'. Relationships between women were frankly distrustful, and few subjects cited women as their friends. Relationships with family members were likely to be strained or fractured, with fathers reported as being absent or dead. The frequently cited finding that women who use crack-cocaine risk HIV transmission through unprotected sexual exchange is confirmed in this study. A broader investigation into the HIV-related risks associated with crack-cocaine use is recommended for both men and women in Alabama. Endnotes 1. The author of this paper is indebted to the women inmates of the Tuscaloosa County Jail who participated in the research. Thanks are also due to the anonymous reviewers, and to Freda Richardson, Tiffany Spencer, James Taggart, Sten Vermund, Stanley L. Brodsky, Ernest Drucker, Richard Holmes and Charles Collins for their advice, information and support. 2. Comments on the focus group data from an African-American perspective were elicited from the following informants: Freda Richardson, nurse, Tuscaloosa County Jail; Tiffany Spencer, research assistant. University of Alabama; Sean Scott, student (Criminal Justice and Sociology, University of Alabama at Birmingham). An interview with James Taggart, Chief of Police Operations at the Tuscaloosa County Jail also provided background information about illicit drug use among women in Tuscaloosa County. 3. The full list of interview questions is available on request from the author.